A report by the Public Services Ombudsman for Wales
A spokesperson for Cwm Taf University Health Board said: “We would like to extend our sincere apologies to Mrs C for the shortcomings in care provided to her and for any distress this has caused.
We deeply regret the delay in responding to the concerns raised by Mrs C and we would like to provide assurance that we have improved our processes with complaints handling, reducing delays.
“The importance of providing accurate and clear clinical details for all requests for investigations (including Radiology) has been communicated to all clinicians by the Medical Director and this continues to be monitored.
“We have put in place a new system for monitoring referrals between clinicians and we continue to participate in the development of electronic systems for making referrals and requests as part of the all-Wales Clinical Portal development.
“Lessons learned from this investigation have been shared at clinical learning and development meetings (Medicine & Radiology) and the learning will continue to be shared across specialities and with trainees.”